System-Centered Care: How Bureaucracy and Racialization Decenter Attempts at Person-Centered Mental Health Care

Abstract

In this study, we explored structural biases in mental health organizations in the context of person-centered care—an emerging framework for health systems globally. The findings revealed how institutional structures powerfully condition clinical operations and providers, creating a risk that clients will be systemically seen as nonpersons, that is, as racialized or bureaucratic objects. Specifically, we elucidate how racial profiles could become determinants of care within institutions and how another, covert form of institutional objectification could emerge, in which clients are reduced to unseen bureaucratic objects. The findings illuminated a basic psychosocial process through which staff could become unwitting carriers of systemic agenda and intentionality—a type of “bureaucra-think”—and also how some providers pushed against this climate. These findings, and emergent novel concepts, add to the severely limited research on institutional bias and racism within psychological science.

Experiences with Racism Among Asian American Medical Students

“…Additional input was provided by a phenomenological perspective, especially regarding the delineation and interrelation of core themes. [30][31][32][33] To ensure dependability and credibility, we maintained an audit trail that included detailed memos on each team meeting. Investigator triangulation and member checking established the validity and trustworthiness of the data.…”

“…Researchers examined associations within and between these codes (axial coding) to identify potentially useful ways to respond to microaggressions and eventually developed core themes (selective coding) that coalesced interview codes into a theoretical framework to explain the data. Additional input was provided by a phenomenological perspective, especially regarding the delineation and interrelation of core themes . To ensure dependability and credibility, we maintained an audit trail that included detailed memos on each team meeting.…”